Adolescents with chronic conditions have to learn to self-manage their health in preparation for transitioning to adult care. Nurses often struggle with how to approach youth with chronic conditions successfully because little is known about the preferences and attitudes of these young people. Jedeloo and colleagues sought to uncover preferences for self-management and hospital care of adolescents with various chronic conditions. A Q-methodological study was conducted. Semi-structured interviews were held with adolescents who rank-ordered 37 opinion statements on preferences for care delivery and self-management. By-person factor analysis was conducted to uncover patterns in the rankings of statements; the factors were described as preference profiles. A purposive sample of 66 adolescents (12-19 years) treated in a university children's hospital in the Netherlands was invited to participate. Thirty-one adolescents, 16 boys and 15 girls with various chronic conditions eventually participated (response 47%). Eight participants (26%) had a recently acquired chronic condition, while the rest (74%) had been diagnosed at birth or in the first 5 years of life. Four distinct preference profiles for health care delivery and self-management were identified: (1) 'Conscious & Compliant'; (2) 'Backseat Patient'; (3) 'Self-confident & Autonomous'; and (4) 'Worried & Insecure'. Profiles differ in the level of independence, involvement with self-management, adherence to therapeutic regimen, and appreciation of the parents' and health care providers' role. The desire to participate in treatment-related decisions was important to all preference profiles recognizable to adolescents and nurses alike. As Q-methodology allows no inferences with respect to the relative distribution of these profiles in a given population, only tentative hypotheses were formulated about associations between profiles and patient characteristics.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that their study increased our understanding of different subjectivities of adolescents living with a chronic condition related to their treatment and health. There is no "one size fits all" approach to adolescent health care, but rather a limited number of distinct preference profiles. The study demonstrates the value of a non-disease-specific approach in that adolescents with various chronic conditions were found to have much in common.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The study showed the uniqueness of patients with respect to a chronic illness. It suggests that the way you perceive your condition is useful to you as there is no one preference pattern that fits all.

S Jedeloo et al. Preferences for health care and self-management among Dutch adolescents with chronic conditions: A Q-methodological investigation. International Journal of Nursing Studies, November 7, 2009.